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Research article:

Short- and long-term risk of premature death in a nationally representative cohort of primary care patients with history of self-harm

Reference:

Matthew J. Carr, Darren M. Ashcroft, Evangelos Kontopantelis, David While, Yvonne Awenat, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T. Webb (2016) Short- and long-term risk of premature death in a nationally representative cohort of primary care patients with history of self-harm. BMJ, doi:

Link to article
Abstract
Objectives: To examine premature mortality in a nationally representative cohort of primary care patients who have harmed themselves, and to estimate relative risks versus the general population stratified by follow-up time from first to tenth year. Design: Matched cohort study. Setting: 385 general practices in England contributing data to the Clinical Practice Research Datalink (CPRD) during 2001-2013 with linkage to national mortality records. Population: Index cohort of 30,017 persons aged 15-64 years with a record of self-harm; comparison cohort, sampled from the same population, consisting of 600,258 persons with no record of self-harm and matched to index patients on age (year of birth), gender and registered general practice. Main outcome measures: Hazards ratios for all-cause and cause-specific mortality, including unnatural vs. natural death, suicide, intentional vs. accidental poisoning, and alcohol-related death. Results: We found greatly raised risk of dying prematurely from any cause among members of the self-harm cohort, especially so during the first follow-up year: hazard ratio (HR) 9.9, 95% confidence interval (CI) 8.6 to 11.4. The elevation in suicide risk within a year was especially great (HR 113.9, CI 73.9 to 175.6). Beyond the first follow-up year, suicide risk declined sharply but remained much higher than in the comparison cohort. Large risk elevations throughout the follow-up period were observed for accidental self-poisoning and alcohol-related death. Conclusions: Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by suicide and by other causes, and especially so within a year of the index episode. Relatively frequent general practice attendance by these individuals presents a clear opportunity for preventive action in primary care. National clinical guidelines could provide more specific recommendations for how primary healthcare teams can monitor, intervene and manage risk in these patients more effectively.
Author for correspondence
Matthew J Carr
Email for correspondence
matthew.carr@manchester.ac.uk

Code list: res41: Benzodiazepines

249 codes in list

Code Coding system Description Entity type List name
00445021 Multilex Lorazepam 500micrograms/5ml oral solution drug res41: Benzodiazepines
10229020 Multilex Diazepam 2mg/5ml oral solution sugar free (A A H Pharmaceuticals Ltd) drug res41: Benzodiazepines
14501021 Multilex Temazepam 10mg tablets (F.Maltby & Sons Ltd) drug res41: Benzodiazepines
20432020 Multilex Lorazepam 5mg/5ml oral solution drug res41: Benzodiazepines
20436020 Multilex Lormetazepam 1mg/5ml oral suspension drug res41: Benzodiazepines
20867020 Multilex Diazepam 10mg/5ml oral solution drug res41: Benzodiazepines
20871020 Multilex Diazepam 2.5mg/5ml oral solution drug res41: Benzodiazepines
28378020 Multilex Midazolam 10mg/ml oral solution drug res41: Benzodiazepines
32064020 Multilex Haloperidol 1.5mg/5ml oral suspension drug res41: Benzodiazepines
36901020 Multilex Midazolam 12.5mg/5ml oral suspension drug res41: Benzodiazepines
37194020 Multilex Midazolam 10mg/2ml oromucosal solution pre-filled syringes (Special Order) drug res41: Benzodiazepines
37195020 Multilex Midazolam 2.5mg/0.5ml oromucosal solution pre-filled syringes (Special Order) drug res41: Benzodiazepines
37196020 Multilex Midazolam 5mg/1ml oromucosal solution pre-filled syringes (Special Order) drug res41: Benzodiazepines
37199020 Multilex Midazolam 7.5mg/1.5ml oromucosal solution pre-filled syringes (Special Order) drug res41: Benzodiazepines
37936020 Multilex Midazolam 7.5mg tablets drug res41: Benzodiazepines
38438020 Multilex Diazepam 2mg/5ml oral suspension drug res41: Benzodiazepines
38820020 Multilex Midazolam 10mg/ml oromucosal solution drug res41: Benzodiazepines
39271020 Multilex Midazolam 10mg/1ml oromucosal solution pre-filled oral syringes drug res41: Benzodiazepines
41200020 Multilex Sondate XL 50mg tablets (Teva UK Ltd) drug res41: Benzodiazepines
46781020 Multilex Temazepam 10mg tablets (Ethigen Ltd) drug res41: Benzodiazepines
47018020 Multilex Clobazam 10mg/5ml oral suspension sugar free drug res41: Benzodiazepines
47019020 Multilex Tapclob 10mg/5ml oral suspension (Martindale Pharmaceuticals Ltd) drug res41: Benzodiazepines
47020020 Multilex Clobazam 5mg/5ml oral suspension sugar free drug res41: Benzodiazepines
47021020 Multilex Tapclob 5mg/5ml oral suspension (Martindale Pharmaceuticals Ltd) drug res41: Benzodiazepines
48188020 Multilex Anxon 15mg Capsule (Beecham Research Laboratories) drug res41: Benzodiazepines
48189020 Multilex Anxon 30mg Capsule (Beecham Research Laboratories) drug res41: Benzodiazepines
48237020 Multilex Atensine 10mg Tablet (Rorer Pharmaceuticals Ltd) drug res41: Benzodiazepines
48244020 Multilex Ativan 1mg Tablet (Wyeth Pharmaceuticals) drug res41: Benzodiazepines
48245020 Multilex Ativan 2.5mg Tablet (Wyeth Pharmaceuticals) drug res41: Benzodiazepines
48605020 Multilex Centrax 10mg Tablet (Parke-davis Research Laboratories) drug res41: Benzodiazepines
48848020 Multilex Dalmane 15mg capsules (Meda Pharmaceuticals Ltd) drug res41: Benzodiazepines
48849020 Multilex Dalmane 30mg capsules (Meda Pharmaceuticals Ltd) drug res41: Benzodiazepines
49121020 Multilex Nitrazepam 5mg Tablet (Berk Pharmaceuticals Ltd) drug res41: Benzodiazepines
49124020 Multilex Nitrazepam 5mg tablets (Wockhardt UK Ltd) drug res41: Benzodiazepines
49130020 Multilex Nitrazepam 5mg tablets (A A H Pharmaceuticals Ltd) drug res41: Benzodiazepines
49133020 Multilex Oxazepam 10mg tablets (A A H Pharmaceuticals Ltd) drug res41: Benzodiazepines
49134020 Multilex Oxazepam 15mg tablets (A A H Pharmaceuticals Ltd) drug res41: Benzodiazepines
49150020 Multilex Oxazepam 10mg tablets (Thornton & Ross Ltd) drug res41: Benzodiazepines
49151020